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Posterior reversible encephalopathy is a clinical syndrome of acute neurological symptoms like seizures, disturbed vision, headache, and altered mental state in the setting of renal failure, heart failure, blood pressure fluctuations, cytotoxic & anti-epileptic drug overdose or withdrawal, autoimmune disorder and eclampsia leading to sub cortical vasogenic edema as a result of endothelial injury. Here we are reporting two cases that presented as altered mental state and diagnosed posterior reversible encephalopathy syndrome (PRES) in the presence of risk factors, including renal, heart failure and eclampsia and fluctuations of blood pressure with subcortical white matter hyperintensities on brain imaging. Our first case had bilateral papilledema and MRI brain revealed subcortical white matter hyperintesities mimicking multiple sclerosis. Second case showed diffusion restrictions in the posterior splenium region with reduced corresponding ADC level (Boomerang sign) on neuroimaging. Both of our patients were managed symptomatically and discharged in a stable condition. The clinicians should be aware of such uncommon presentations of PRES in view varied clinical and radiological features.

journal of neurology and experimental neuroscience

Posterior Reversible Encephalopathy Syndrome (PRES) Associated with Papilledema Mimicking Multiple Sclerosis and Boomerang Sign on Imaging: Report of Two Cases